CommercialCoverageMedium impact
Total Parenteral Nutrition (TPN) or Hyperalimentation 11.01.04
Excellus BlueCross BlueShield·Gastroenterology, Oncology, General Surgery +3 more·Food (Nutrition)
Effective date
Feb 19, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their Total Parenteral Nutrition (TPN) policy effective February 19, 2026, defining specific medical necessity criteria for TPN coverage including gastrointestinal failure, Crohn's disease, severe mucosal injury, and other conditions. The policy establishes strict criteria for home TPN coverage and specifies when TPN is considered not medically necessary.
Action Required
Before February 19, 2026: Billing team must review all TPN claims to ensure they meet the new medical necessity criteria outlined in the policy. Providers must document malnutrition indicators including weight loss, serum albumin <2.5 grams, BUN <10 mg, phosphorous <2.5 mg, and that patient can receive no more than 30% of caloric needs enterally. Update prior authorization requests to include these specific clinical indicators and ensure enteral nutrition has been attempted or contraindicated before TPN authorization.